Focused Physical Examination (Medical and Trauma) - NREMT: EMT Level

Identify and manage specific complaints or suspected injuries. Following the primary assessment, the focused exam targets the patient's chief complaint or injury to guide appropriate interventions and management.

Stable patient with a specific chief complaint or isolated injury. Focused exams are appropriate for stable patients where the issue is localized, allowing targeted assessment without the need for a full rapid evaluation.

Mental status, pupils, scalp/face DCAP-BTLS, C-spine, neuro status, vitals. These assessments detect intracranial pressure changes, external injuries, and neurologic deficits while monitoring for instability in head trauma.

Inspect/Palpate, PMS check, control bleeding, splint, reassess PMS. This sequence ensures thorough evaluation, stabilization, and monitoring to prevent neurovascular compromise in an isolated but significant injury.

Every $5$ minutes. Frequent reassessment every $5$ minutes allows early detection of deterioration and evaluation of intervention effectiveness in unstable patients.

Pulse, Motor function, Sensation, Capillary refill, Skin color/temperature. These components evaluate neurovascular integrity distal to the injury, ensuring no compromise from swelling, bleeding, or compartment syndrome.

Loss of motor or sensory function below the suspected injury level. This deficit suggests disruption of neural pathways, indicating the need for spinal immobilization and further evaluation to prevent worsening.

Airway/breathing, respiratory rate/effort, pupils, mental status, vitals. These elements focus on detecting respiratory depression and altered consciousness, which are hallmarks of opioid toxicity requiring immediate reversal.

Airway patency and signs of respiratory compromise or shock. Prioritizing airway and circulation is essential as allergic reactions can rapidly progress to anaphylaxis, compromising breathing and perfusion.

Work of breathing, lung sounds, SpO2, accessory muscle use, speech ability. These indicators assess the severity of respiratory distress and guide interventions like bronchodilators for conditions such as asthma.

Treat hypoglycemia per protocol and reassess neurologic status. Hypoglycemia can mimic stroke symptoms, so treatment restores glucose levels, allowing differentiation and potential resolution of neurologic deficits.

Battle sign, raccoon eyes, or CSF leakage from nose/ears. These are pathognomonic signs of basilar skull fracture due to blood or fluid tracking along fracture lines, indicating potential severe injury.

FAST (or stroke scale), glucose check, vitals, focused neuro exam. These assessments help confirm stroke suspicion, rule out mimics like hypoglycemia, and monitor for changes in the prehospital environment.

Abdominal tenderness with rigidity or guarding. These signs indicate peritonitis or organ injury, which are critical indicators of potential internal hemorrhage requiring urgent intervention.

Signs/Symptoms, Allergies, Medications, Past history, Last oral intake, Events. SAMPLE is a mnemonic for obtaining pertinent medical history to contextualize the patient's current condition and inform treatment decisions.

Onset, Provocation, Quality, Region/Radiation, Severity, Time. OPQRST is a mnemonic for gathering detailed history on pain to understand its characteristics and guide differential diagnosis in medical assessments.

OPQRST/SAMPLE, lung sounds, skin signs, perfusion, vitals, ECG if available. These elements provide a comprehensive evaluation of cardiac-related chest pain, incorporating history, physical signs, and monitoring for timely intervention.

Inspect, palpate chest wall, assess breath sounds, check for crepitus. These steps evaluate for complications like pneumothorax or instability while ensuring the injury is isolated in a stable patient.

Palpate gently from distal to proximal, comparing bilaterally when possible. This method minimizes patient discomfort and helps identify the extent of injury by starting from the least painful area and using comparison for abnormalities.

Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling. DCAP-BTLS is a mnemonic used to systematically identify visible and palpable signs of trauma during focused examinations.

Any change in mental status or increased work of breathing. These signs indicate potential deterioration in airway or breathing status, necessitating prompt reevaluation to prevent life-threatening complications.

Inspect, auscultate, palpate. This sequence allows systematic evaluation of the abdomen, starting with visual inspection, followed by listening for bowel sounds, and then gentle palpation.

The injured extremity and adjacent joints above and below. Examining the injured area and adjacent joints ensures detection of associated injuries or complications that may not be immediately apparent.